Introduction

Changing health behaviour is a prominent theme in both government health policy and professional practice and, prior to 1997, formed the basis of the government's strategy for addressing health inequalities, or health variations as they were then officially known (Warden, 1995). By 1998, it appeared that the emphasis had shifted from changing behaviour to changing the underlying material and structural conditions associated with both adverse health behaviours and poor health among the disadvantaged. The New Labour government accepted the conclusions of the Acheson Inquiry (Acheson, 1998), echoing those of the Black Report (Townsend and Davidson, 1982), that tackling health inequalities required attention to the structural and material factors underpinning health-related behaviours if they were to be changed. Acheson identified reducing poverty and improving material circumstances as key planks of policy to reducing health inequalities in England. Health behaviour change, including the promotion of smoking cessation, improvement of diet and nutrition and promotion of breastfeeding, was included in the recommendations but set within the social and material context in which health behaviour occurs (see Chapter Eight in this volume for a detailed discussion of dietary and nutritional issues in relation to health inequalities). Government publications explicitly recognised that sustained action on the wider determinants of health would be needed if health inequalities were to be significantly reduced (HM Treasury and DH, 2002). The recent public health White Paper, Choosing health: Making healthier choices easier (DH, 2004), however, represents a shift away from materialist explanations of health inequalities by placing health behaviour change at the forefront of public health policy. As the title of the White Paper suggests, its objective is to help the public to ‘choose’ better health and less emphasis is placed on policy initiatives to address the wider determinants of health inequalities (see Chapters Three, Four, Five and Eight for further discussion of the policy shift represented by Choosing health).

Against the background of this shifting policy agenda, this chapter offers an overview of recent health policy initiatives aimed at smoking reduction and the theoretical debates on the effectiveness of policies that seek to reduce health inequalities through changing individual smoking behaviour. Using cigarette smoking as an exemplar, it will examine some of the issues that those concerned with health behaviour change face. Cigarette smoking is the major cause of premature and preventable death in England.